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Development of Persistent Respiratory Morbidity in Previously Healthy Children After Acute Respiratory Failure
Garrett Keim1, Nadir Yehya1, Debbie Spear2
1Department of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA.
Insights
Up to 44% of previously healthy children may experience persistent respiratory issues after mechanical ventilation for acute respiratory failure. Bacterial respiratory infections are linked to ongoing pulmonary problems in these children.
Area of Science:
- Pediatric critical care medicine
- Pulmonology
- Epidemiology
Background:
- Acute respiratory failure is a common reason for pediatric intensive care unit (PICU) admission.
- Long-term pulmonary health effects in previously healthy children after mechanical ventilation are not well understood.
Purpose of the Study:
- To determine if clinical course or mechanical ventilation characteristics predict persistent respiratory morbidity in children after acute respiratory failure.
- To investigate the prevalence and predictors of respiratory morbidity at 6 and 12 months post-discharge.
Main Methods:
- Prospective cohort study involving 255 children admitted to 10 U.S. PICUs.
- Follow-up questionnaires assessed respiratory morbidity at 6 and 12 months.
- Multivariate regression identified independent predictors of pulmonary dysfunction and persistent morbidity.
Main Results:
- Pulmonary dysfunction at discharge occurred in 34% of patients; positive bacterial respiratory culture was a predictor.
- Persistent respiratory morbidity was observed in 42% at 6 months and 44% at 12 months.
- Pulmonary dysfunction at discharge and prior morbidity predicted future respiratory issues; bacterial culture remained a predictor.
Conclusions:
- Up to 44% of previously healthy children may develop persistent respiratory morbidity after mechanical ventilation for acute respiratory failure.
- Positive bacterial respiratory culture is associated with both initial pulmonary dysfunction and persistent respiratory morbidity.
- This study highlights the significant long-term respiratory impact of acute respiratory failure in previously healthy children.
Objectives:
Acute respiratory failure is a common reason for admission to PICUs. Short- and long-term effects on pulmonary health in previously healthy children after acute respiratory failure requiring mechanical ventilation are unknown. The aim was to determine if clinical course or characteristics of mechanical ventilation predict persistent respiratory morbidity at follow-up.
Design:
Prospective cohort study with follow-up questionnaires at 6 and 12 months.
Setting:
Ten U.S. PICUs.
Patients:
Two-hundred fifty-five children were included in analysis after exclusion for underlying chronic disease or incomplete data. One-hundred fifty-eight and 130 children had follow-up data at 6 and 12 months, respectively.
Interventions:
None.
Measurements And Main Results:
Pulmonary dysfunction at discharge a priori defined as one of: mechanical ventilation, supplemental oxygen, bronchodilators or steroids at 28 days or discharge. Persistent respiratory morbidity a priori defined as a respiratory PedsQL, a pediatric quality of life measure, greater than or equal to 5 or asthma diagnosis, bronchodilator or inhaled steroids, or unscheduled clinical evaluation for respiratory symptoms. Multivariate backward stepwise regression using Akaike information criterion minimization determined independent predictors of these outcomes. Pulmonary dysfunction at discharge was present in 34% of patients. Positive bacterial respiratory culture predicted pulmonary dysfunction at discharge (odds ratio, 4.38; 95% CI, 1.66-11.56). At 6- and 12-month follow-up 42% and 44% of responders, respectively, had persistent respiratory morbidity. Pulmonary dysfunction at discharge was associated with persistent respiratory morbidity at 6 months, and persistent respiratory morbidity at 6 months was strongly predictive of 12-month persistent respiratory morbidity (odds ratio, 18.58; 95% CI, 6.68-52.67). Positive bacterial respiratory culture remained predictive of persistent respiratory morbidity in patients at both follow-up points.
Conclusions:
Persistent respiratory morbidity develops in up to potentially 44% of previously healthy children less than or equal to 24 months old at follow-up after acute respiratory failure requiring mechanical ventilation. This is the first study, to our knowledge, to suggest a prevalence of persistent respiratory morbidity and the association between positive bacterial respiratory culture and pulmonary morbidity in a population of only previously healthy children with acute respiratory failure.
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